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Organization
ILLINOIS RETINA INSTITUTE, SC
Active
Organization
ILLINOIS RETINA INSTITUTE, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMAL KISHORE MD (PRESIDENT)
(815) 223-7400
Entity
Organization
Contact information
Practice address
3602 MARQUETTE RD, PERU, IL 61354-1450
(815) 223-7400
(815) 223-7477
Mailing address
PO BOX 36, PERU, IL 61354-0036
(815) 223-7400
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036100858
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100858
—
IL
Enumeration date
03/23/2006
Last updated
10/30/2015
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